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CA DHCS 6170 2015-2026 free printable template

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Print Form State of California-Health and Human Services Agency Department of Health Care Services Readmission Screening and Resident Review (PARR) Level I Screening Document The federal Omnibus Reconciliation
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How to fill out CA DHCS 6170

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How to fill out CA DHCS 6170

01
Download the CA DHCS 6170 form from the official website.
02
Review the instructions provided with the form.
03
Fill out the applicant's personal information section, including name, date of birth, and contact details.
04
Provide details regarding the individual's eligibility for the program, including income and residency information.
05
If applicable, complete the information related to family members or dependents.
06
Sign and date the form to certify that all information is accurate and complete.
07
Submit the completed form to your local DHCS office or as directed in the instructions.

Who needs CA DHCS 6170?

01
Individuals applying for Medi-Cal benefits in California.
02
Those who need assistance with healthcare coverage based on income and other eligibility criteria.
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People Also Ask about

DEPARTMENT OF HEALTH CARE SERVICES.
Core Values: Integrity, Service, Accountability and Innovation.
Telephone Service Center: (800) 541-5555.
The goal of CalAIM is to improve outcomes for the millions of Californians covered by Medi-Cal, especially those with the most complex needs.
​The mission of DHCS is to provide Californians with access to affordable, integrated, high-quality health care, including medical, dental, mental health, substance use treatment services and long-term care. Our vision is to preserve and improve the overall health and well-being of all Californians.
​​​​About Director Michelle Baass​​ Ms. Baass leads a team of more than 4,000 individuals at DHCS.

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CA DHCS 6170 is a form used by the California Department of Health Care Services to report information regarding Medi-Cal services provided to beneficiaries.
Providers of Medi-Cal services are required to file CA DHCS 6170 if they are participating in the Medi-Cal program and providing services to beneficiaries.
To fill out CA DHCS 6170, ensure you provide accurate information regarding the services rendered, including the client details, service dates, and codes that correspond to the services provided.
The purpose of CA DHCS 6170 is to gather necessary data about Medi-Cal services in order to track utilization, ensure compliance, and facilitate reimbursement for the services rendered.
The CA DHCS 6170 requires information such as beneficiary identification, service provider details, dates of service, type of services provided, and any relevant codes associated with the services.
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